Cold Urticaria: When Exposure to Cold Causes a Rash

     Cold urticaria is an immune system overreaction to cold exposure. Contact with cold air, water, or objects may trigger red, raised, itchy, or burning rashes on the skin. Symptoms typically appear immediately or within minutes.

Symptoms

• Raised, itchy, red rashes or swelling at points of contact (hands, feet, face, lips).
• Burning or pain in some cases.
• In severe cases (e.g., full-body cold exposure like swimming), symptoms may include difficulty breathing, dizziness, low blood pressure, or anaphylaxis.

Risk Factors

• Often begins in adolescence or early adulthood.
• Associated with a history of allergies (e.g., food allergies, atopic conditions).
• May occur spontaneously without a family history.
• Sometimes triggered by viral infections or certain medications.

Causes of Disease

     The exact cause is unknown. It is believed to involve an abnormal immune response to low temperatures or sudden temperature changes, leading to histamine release, which causes itching and rashes.

Diagnosis

• Clinical history and symptom assessment.
• Ice cube test: placing wrapped ice on the skin for 1–5 minutes to observe for rash development.

Management

Although there is no cure, symptoms can be controlled:

• Avoid cold exposure; refrain from swimming in cold water.
• Dress warmly in cold weather.
• Use antihistamines to reduce rashes and itching.
• Monitor symptoms with a dermatologist or allergist (photos of rashes may help).
• In severe cases, additional medications like Omalizumab or emergency Epinephrine may be prescribed.

Cold urticaria should be recognized early, especially during cold weather. If symptoms appear after exposure to low temperatures, medical consultation is advised for proper diagnosis and treatment.